ASSISTING WITH HYGIENE CHAPTER FOURTEEN ASSISTING WITH GROOMING CHAPTER THIRTEEN ASSISTING WITH HYGIENE CHAPTER FOURTEEN ASSISTING WITH GROOMING

PERSONAL CARE INCLUDES: BATHING BRUSHING THE TEETH COMBING THE HAIR DRESSING SHAVING APPLYING MAKEUP PATIENTS SHOULD BE ENCOURAGED TO DO AS MUCH FOR THEMSELVES AS POSSIBLE

WHY IS CLEANLINESS IMPORTANT? CLEANLINESS IS NEEDED FOR COMFORT, SAFETY, AND HEALTH CLEANLINESS MAINTAINS THE HEALTH OF THE SKIN AND MUCOUS MEMBRANES CLEANLINESS PREVENTS BODY AND BREATH ODORS, PROMOTES RELAXATION, AND INCREASES CIRCULATION

CULTURE AND PERSONAL CHOICE SOME PEOPLE PREFER SHOWERS, OTHERS PREFER TUB BATHS SOME PEOPLE BATHE IN THE MORNING , SOME BATHE AT BEDTIME BATHING FREQUENCY VARIES AMONG INDIVIDUALS OR CULTURES SOME PEOPLE CANNOT AFFORD SOAP, DEODORANT, SHAMPOO, TOOTHPASTE, OR OTHER HYGIENE PRODUCTS

PROTECT THE PATIENT’S PRIVACY DURING HYGIENE AND PERSONAL CARE PROCEDURES THE NEED FOR CLEANLINESS AND SKIN CARE IS AFFECTED BY: PERSPIRATION VOMITING URINARY AND BOWEL ELIMINATION DRAINAGE FROM WOUNDS OR BODY OPENINGS ACTIVITY

GIVEN BEFORE BREAKFAST WHEN THE RESIDENT FIRST WAKES UP DAILY CARE ROUTINES EARLY MORNING CARE AM CARE GIVEN BEFORE BREAKFAST WHEN THE RESIDENT FIRST WAKES UP ASSIST WITH ELIMINATION CLEAN INCONTINENT PERSONS ASSIST WITH WASHING FACE AND HANDS PROVIDE ORAL HYGIENE AND PUT IN DENTURES ASSIST WITH DRESSING AND HAIR CARE POSITION THE PERSON FOR BREAKFAST BEGIN MAKING BEDS

MORNING CARE GIVEN AFTER BREAKFAST ASSIST WITH ELIMINATION CLEAN INCONTINENT PERSONS ASSIST WITH ORAL HYGIENE ASSIST WITH BATHING ( SHOWER, TUB, PARTIAL ) ASSIST WITH PERINEAL CARE ASSIST WITH DRESSING ASSIST WITH GROOMING ( COMB HAIR, SHAVE, APPLY MAKEUP ) ASSIST WITH ACTIVITIES – ROM, AMBULATION MAKE BEDS AND STRAIGHTEN THE RESIDENT’S UNIT

AFTERNOON CARE GIVEN AFTER LUNCH ASSIST WITH ELIMINATION CLEAN INCONTINENT PERSONS ASSIST WITH WASHING FACE AND HANDS ASSIST WITH ORAL HYGIENE ASSIST WITH GROOMING – CHANGING CLOTHING, HAIR CARE ASSIST WITH ACTIVITIES – ROM, AMBULATION STRAIGHTEN THE BED LINENS AND THE RESIDENT’S UNIT

GIVEN AT BEDTIME (HOUR OF SLEEP) EVENING CARE PM CARE HS CARE GIVEN AT BEDTIME (HOUR OF SLEEP) ASSIST WITH ELIMINATION CLEAN INCONTINENT PERSONS ASSIST WITH WASHING FACE AND HANDS ASSIST WITH ORAL HYGIENE ( REMOVE DENTURES ) ASSIST WITH NIGHTCLOTHES GIVE BACKRUB POSITION RESIDENT AND STRAIGHTEN LINEN STRAIGHTEN RESIDENT’S UNIT

ORAL HYGIENE MOUTH CARE KEEPS THE MOUTH AND TEETH CLEAN - PREVENTS MOUTH ODORS PREVENTS INFECTIONS INCREASES COMFORT MAKES FOOD TASTE BETTER PREVENTS CAVITIES MUST BE DONE FOR: WEAK PERSONS CONFUSED PERSONS PEOPLE THAT CANNOT USE THEIR ARMS

ORAL HYGIENE INCLUDES: BRUSHING THE TEETH, GUMS, AND TONGUE FLOSSING THE TEETH (REMOVES PLAQUE AND TARTAR) RINSING THE MOUTH WITH MOUTHWASH BRUSH THE TEETH IN AN UP AND DOWN MOTION, BRUSHING ALL SURFACES OF THE TEETH CLEANING DENTURES IS ALSO A PART OF ORAL HYGIENE

OBSERVATIONS DRY, CRACKED, SWOLLEN, OR BLISTERED LIPS UNPLEASANT MOUTH ODORS LOOSE, BROKEN OR DECAYED TEETH SWELLING , REDNESS, SORES, BLEEDING, OR WHITE PATCHES IN THE MOUTH OR ON THE TONGUE BLEEDING, SWELLING, OR REDNESS OF THE GUMS LOOSE, CHIPPED, OR BROKEN DENTURES PATIENT COMPLAINTS

SOME PATIENTS WILL BE ABLE TO PERFORM ORAL HYGIENE INDEPENDENTLY. OTHERS MAY NEED YOU TO ASSIST WITH ORAL HYGIENE SOME MAY NEED YOU TO PROVIDE THE CARE FOR THEM ORAL HYGIENE IS INCLUDED IN OUR ADL’S IT SHOULD BE PROVIDED IN THE MORNING, AFTER MEALS, AND AT BEDTIME.

ORAL HYGIENE IS GIVEN EVERY TWO HOURS FOR THE: COMATOSE PATIENT PATIENT WITH A NASOGASTRIC TUBE PATIENT RECEIVING OXYGEN

PROVIDING ORAL CARE FOR THE COMATOSE PATIENT THE MOUTH OF AN UNCONSCIOUS PERSON MAY HANG OPEN CAUSING THE MOUTH AND MUCOUS MEMBRANES TO DRY OUT. OR ORAL SECRETIONS MAY ACCUMULATE IN THE MOUTH DUE TO THE PERSON’S INABILITY TO COUGH OR CLEAR THE THROAT. THESE CONDITIONS MAY LEAD TO DISCOMFORT AND THE GROWTH OF PATHOGENS.

ALWAYS WEAR GLOVES WHEN PERFORMING ORAL HYGIENE. POSITION THE COMATOSE PATIENT ON HIS SIDE TO PREVENT ASPIRATION. PLACE A TOWEL UNDER THE PATIENT’S HEAD TO CATCH SECRETIONS. USE A PADDED TONGUE BLADE TO OPEN THE PERSON’S MOUTH.

A SPONGY PIECE OF FOAM ON A STICK – CALLED A TOOTHETTE IS USED TO CLEAN THE MOUTH OF A COMATOSE PATIENT. MAKE SURE THE SPONGE IS TIGHT ON THE STICK. CHECK THE CARE PLAN FOR WHAT CLEANING AGENT TO USE, USUALLY DILUTED MOUTHWASH. MAY ALSO USE A LARGE, PREPACKAGED COTTON SWAB CALLED A LEMON & GLYCERIN SWAB

BE SURE TO USE ONLY A SMALL AMOUNT OF FLUID TO PREVENT ASPIRATION ALWAYS ASSUME THE UNCONSCIOUS PERSON CAN HEAR YOU. ALWAYS EXPLAIN WHAT YOU ARE DOING.

DENTURE CARE DENTURES SHOULD BE CLEANED AS OFTEN AS NATURAL TEETH. DENTURES ARE SLIPPERY WHEN WET. THEY CAN EASILY BREAK IF DROPPED ONTO A HARD SURFACE. DENTURES ARE EXPENSIVE AND ARE THE RESIDENT’S PERSONAL PROPERTY. LOSING OR DAMAGING DENTURES IS NEGLIGENT CONDUCT. CARRY THE DENTURES BACK AND FORTH FROM THE SINK IN AN EMESIS BASIN LINED WITH A PAPER TOWEL.

USE A GAUZE PAD TO GRASP THE UPPER DENTURE AND USING YOUR THUMB GENTLY BREAK THE SUCTION HOLDING THE DENTURE IN PLACE.

CLEAN THE DENTURES IN A BASIN OR SINK LINED WITH PAPER TOWELS OR A WASHCLOTH. FILL THE BASIN OR SINK PART WAY WITH COOL WATER USE COOL WATER TO CLEAN THE DENTURES. ( HOT WATER WILL CAUSE THEM TO WARP ) STORE THE DENTURES IN COOL WATER IN THE PERSON’S DENTURE CUP CHECK THE LINEN WHEN STRIPPING THE BED OR THE MEAL TRAY BEFORE RETURNING IT FOR WAYWARD DENTURES.

BACKRUBS BACKRUBS ARE USED TO STIMULATE THE PATIENT’S CIRCULATION, PREVENT SKIN BREAKDOWN, AND SOOTHE AND REFRESH THE PATIENT. USE LOTION TO PREVENT FRICTION. WARM THE LOTION UNDER WARM, RUNNING WATER. STROKE UPWARD USING LONG, FIRM STROKES THEN RETURN WITHOUT LIFTING YOUR HANDS FROM THE BACK. USE CIRCULAR MOTIONS TO MASSAGE THE BONY AREAS OF THE BACK.

SOME PATIENTS ARE NOT ALLOWED TO HAVE BACK RUBS! CHECK WITH THE NURSE AND THE CARE PLAN IF WHEN APPLYING LOTION YOU NOTICE REDDENED AREAS OF SKIN--- MASSAGE AROUND THE AREA BUT NOT OVER THE REDDENED AREA

RESTORATIVE SKIN CARE WHEN GIVING A BATH YOU CAN EXAMINE THE PATIENT’S ENTIRE BODY. OBSERVE AND REPORT SKIN THAT IS: PALE, DARK, OR REDDENED IN COLOR. ROUGH OR CHAPPED IN TEXTURE. DRY OR FLAKING, LACKING IN MOISTURE. INJURED (BLISTERS, BRUISES, OR LACERATIONS) SORE (PRESSURE SORES OR INFECTIONS)

FOUR MAIN TYPES OF BATHS BENEFITS OF BATHING REMOVES PERSPIRATION, DIRT, AND GERMS REFRESHES PATIENTS AND MAKES THEM MORE COMFORTABLE STIMULATES CIRCULATION HELPS PREVENT SKIN PROBLEMS PROVIDES EXERCISE FOUR MAIN TYPES OF BATHS COMPLETE BED BATH PARTIAL BED BATH TUB BATH SHOWER

RULES FOR BATHING ASK THE NURSE OR CHECK THE CARE PLAN TO DETERMINE WHAT TYPE OF BATH THE PERSON SHOULD HAVE. ENCOURAGE THE PATIENT TO DO AS MUCH OF THE BATH AS HE CAN. OFFER THE BEDPAN OR URINAL BEFORE YOU BEGIN THE PROCEDURE. COLLECT ALL THE EQUIPMENT NECESSARY BEFORE BEGINNING THE PROCEDURE. PROTECT THE PERSON’S PRIVACY. CLOSE DOORS, CURTAINS, AND KEEP THE PERSON COVERED WITH A BATH BLANKET. KEEP THE WATER AT A SAFE TEMPERATURE.

RULES FOR BATHING USE GOOD BODY MECHANICS USE STANDARD PRECAUTIONS AS NEEDED PROTECT THE PERSON FROM FALLING WASH FROM THE CLEANEST AREA TO THE DIRTIEST AREA RINSE ALL AREAS THROUGHLY PAT SKIN DRY. DO NOT RUB THE SKIN DRY UNDER BREASTS, BETWEEN SKIN FOLDS, AND BETWEEN TOES BATHE SKIN WHENEVER URINE OR FECES IS PRESENT

MAKE A MITT WITH THE WASHCLOTH

INVOLVES WASHING THE PERSON’S ENTIRE BODY IN BED. COMPLETE BED BATH A COMPLETE BED BATH IS GIVEN TO PATIENTS WHO ARE NOT ABLE TO BATHE THEMSELVES. INVOLVES WASHING THE PERSON’S ENTIRE BODY IN BED. PERSONS WHO ARE: UNCONSCIOUS PARALYZED IN A CAST OR TRACTION WEAK FROM ILLNESS OR SURGERY

PROCEDURE FOR BED BATHING PLACE EVERYTHING YOU NEED ON THE OVERBED TABLE BEFORE BEGINNING THE BATH. RAISE THE BED TO A COMFORTABLE HEIGHT AND RAISE THE RAIL ON THE FAR SIDE OF THE BED. WASH ONLY ONE PART OF THE BODY AT A TIME. WASH, RINSE, AND DRY EACH PART AND THEN COVER IT WITH THE BATH BLANKET. CHANGE THE WATER IN THE BASIN WHENEVER IT BECOMES SOAPY, DIRTY, OR COOL. KEEP THE SOAP IN THE SOAP DISH BETWEEN LATHERINGS. WASH FROM THE CLEANEST TO THE DIRTEST AREAS.

PLACE THE TOWEL OVER THE PATIENT’S CHEST PLACE THE TOWEL OVER THE PATIENT’S CHEST. LIFT THE CORNER AS YOU WASH THE CHEST. REPEAT FOR THE ABDOMEN. WASH THE EYES FIRST. FROM THE INSIDE CORNER TO THE OUTSIDE, USING A DIFFERENT AREA OF THE CLOTH FOR EACH EYE. AFTER WASHING THE FACE, NECK, AND EARS, REMOVE THE GOWN AND WASH THE ARMS, ONE AT A TIME. WASH AND DRY ONE LEG AT A TIME. CHANGE THE WATER AT THIS TIME IF YOU HAVE NOT ALREADY NEEDED TO DO SO. WASH THE BACK AND THE BUTTOCKS. A BACKRUB MAY BE GIVEN AT THIS TIME.

PARTIAL BATH INVOLVES WASHING THE AREAS OF THE BODY THAT CAUSE DISCOMFORT AND ODOR OR NEED DAILY CLEANING. THE AREAS THAT ARE WASHED IN A PARTIAL BATH ARE THE FACE, HANDS, AXILLAE, BACK, AND PERINEAL AREA. OR A PARTIAL BATH MAY REFER TO BATHING THE AREAS THAT THE PATIENT CAN NOT REACH WHEN HE IS BATHING HIMSELF IN BED.

TUB BATH SAFETY MEASURES: BECAUSE OF SAFETY CONCERNS TUB BATHS ARE NOT FREQUENTLY GIVEN IN MOST NURSING HOMES. SAFETY MEASURES: NEVER LEAVE A PATIENT ALONE IN THE TUB. A BATH SHOULD LAST NO LONGER THAN 20 MINUTES. PLACE A TOWEL ON THE BOTTOM OF THE TUB TO PREVENT SLIPPING. ADJUST THE WATER TEMPERATURE TO 105° DRAIN THE TUB BEFORE THE PERSON GETS OUT. CLEAN THE TUB BEFORE AND ATER USE.

A RESIDENT WILL BE PLACED ON A SHOWER CHAIR TO RECEIVE A SHOWER NEVER LEAVE THE PATIENT ALONE ON THE SHOWER CHAIR OR IN THE SHOWER ROOM. ADJUST THE WATER TEMPERATURE BEFORE YOU PLACE THE PERSON IN THE SHOWER. CLEAN THE SHOWER BEFORE AND AFTER USE. GLOVES MAY BE WORN WHILE BATHING A PATIENT IF DESIRED.

BE SURE TO LOCK BOTH CHAIRS BEFORE TRANSFERRING RESIDENTS WILL NEED TO BE TRANSFERRED FROM THEIR WHEELCHAIR TO THE SHOWER CHAIR BE SURE TO LOCK BOTH CHAIRS BEFORE TRANSFERRING REMEMBER SHOWER FLOORS CAN BE SLIPPERY! ALWAYS HAVE NON-SKID FOOTWEAR ON RESIDENT BEFORE STANDING FOR TRANSFER

SPECIALTY BATH A PORTABLE TUB CAN BE USED FOR COMATOSE PATIENTS A WHIRLPOOL BATH HELPS TO STIMULATE CIRCULATION AND RELAX MUSCLES

INVOLVES THE CLEANING OF THE GENITAL AND ANAL AREAS OF THE BODY PERINEAL CARE INVOLVES THE CLEANING OF THE GENITAL AND ANAL AREAS OF THE BODY THE PERINEAL AREA IS WARM, DARK, AND MOIST AND SO PROVIDES AN IDEAL ENVIRONMENT FOR MICROORGANISMS TO GROW. THE AREAS ARE CLEANED AT LEAST ONCE DAILY TO PREVENT INFECTION AND ODORS AND TO PROVIDE COMFORT. PERI-CARE SHOULD BE PROVIDED AFTER EACH INCONTINENT EPISODE. USE STANDARD PRECAUTIONS. MAY HAVE TO USE THE TERM PRIVATE AREA

FEMALE PERI-CARE ALWAYS CLEANSE FROM THE URINARY MEATUS TOWARD THE ANUS. ( CLEAN TO DIRTY ) MAY HAVE A PREPACKAGED KIT OR USE WET WASHCLOTHS. USE A DIFFERENT PART OF THE WASHCLOTH FOR EACH STROKE TO CLEAN THE ANAL AREA , CLEANSE FROM THE VAGINA TOWARD THE ANUS (CLEAN TO DIRTY)

MALE PERI-CARE START AT THE URINARY MEATUS AND USE CIRCULAR MOTIONS AS YOU WIPE DOWNWARD TO THE BASE RETRACT THE FORESKIN IF THE PATIENT IS UNCIRCUMCISED RETURN THE FORESKIN TO ITS NATURAL POSITION WHEN YOU ARE FINISHED

SKIN AND SCALP CONDITIONS ALOPECIA – HAIR LOSS MAY RESULT FROM HEREDITY HAIR MAY THIN WITH AGING MAY BE RESULT OF CANCER TREATMENTS HIRSUTISM – EXCESSIVE BODY HAIR CAN OCCUR IN MEN, WOMEN, OR CHILDREN MAY RESULT FROM HEREDITY OR HORMONE IMBALANCE

SKIN AND SCALP CONDITIONS DANDRUFF – EXCESSIVE AMOUNT OF DRY, WHITE FLAKES FROM THE SCALP PEDICULOSIS – INFESTATION OF LICE. CAPITUS – INFESTATION OF THE SCALP PUBIS – INFESTATION OF PUBIC HAIR CORPORIS – INFESTATION OF BODY HAIR SCABIES – SMALL MITES BURROW UNDER THE SKIN AND LAYS EGGS.

HAIR CARE PEOPLE FEEL BETTER ABOUT THEMSELVES WHEN THEIR HAIR IS COMBED AND LOOKS ATTRACTIVE. PATIENTS SHOULD BE ASKED HOW THEY WOULD LIKE THEIR HAIR STYLED. DO NOT CHANGE A PATIENT’S HAIRSTYLE WITHOUT PERMISSION. NEVER CUT A PATIENT’S HAIR. MAKE SURE THE STYLE IS AGE-APPROPRIATE.

SHAMPOOING THE HAIR THE HAIR IS USUALLY SHAMPOOED DURING THE RESIDENT’S SHOWER PUT A WASHCLOTH OVER THE PATIENT’S EYES RETURN MEDICATED SHAMPOO TO THE NURSE TIP THE PERSON’S HEAD BACK TO PREVENT THE SHAMPOO FROM RUNNING IN THE EYES A SHAMPOO TRAY CAN BE USED TO SHAMPOO THE HAIR OF A BEDBOUND PATIENT

SHAVING THE PATIENT ALWAYS WEAR GLOVES. PLACE A TOWEL ON THE PATIENT’S CHEST APPLY SHAVING CREAM TO THE FACE SHAVE IN THE DIRECTION OF HAIR GROWTH HOLD THE SKIN TAUT WITH YOUR OTHER HAND RINSE THE RAZOR FREQUENTLY WASH THE FACE WHEN FINISHED

CARING FOR MUSTACHES AND BEARDS DAILY WASHING AND COMBING ARE NEEDED NEVER TRIM OR SHAVE A BEARD OR MUSTACHE WITHOUT THE PERSON’S CONSENT

SHAVING LEGS AND UNDERARMS PRACTICE VARIES AMONG CULTURES USUALLY SHAVED AFTER BATHING WEAR GLOVES AND FOLLOW STANDARD PRECAUTIONS UNDERARMS – SHAVE IN DIRECTION OF HAIR GROWTH LEGS – START AT ANKLE AND SHAVE UP THE LEG APPLY DIRECT PRESSURE TO CUTS

NAIL CARE SOAKING THE HANDS HELPS TO SOFTEN THE NAILS BEFORE TRIMMING. SOAK FINGERNAILS FOR 5 TO 10 MINUTES ALWAYS USE A NAIL CLIPPER- NEVER SCISSORS FILE ROUGH NAILS WITH AN EMERY BOARD DO NOT TRIM TOENAILS!! ONLY AN RN OR DR. CAN TRIM TOENAILS.

LET THE NURSE KNOW IF THE PATIENT’S TOENAILS NEED TRIMMING. EXAMINE THE FEET FOR: INGROWN NAILS HANG NAILS BROKEN OR TORN NAILS BLISTERS, RASH, OR REDDENED AREA CALLUSES AND CORNS SKIN BREAKS AND OTHER INJURIES. CHECK BETWEEN THE TOES FOR CRACKS AND SORES. COMPLAINTS OF PAIN OR ITCHING LET THE NURSE KNOW IF THE PATIENT’S TOENAILS NEED TRIMMING.

SOAKING THE FEET SOAK FEET FOR 15 TO 20 MINUTES CHECK WITH RN FOR WATER TEMPERATURE. AFTER SOAKING, APPLY LOTION TO THE FEET. DO NOT APPLY BETWEEN THE TOES. MAKE SURE YOU DRY THROUGHLY BETWEEN THE TOES FOLLOW STANDARD PRECAUTIONS

ASSISTING WITH DRESSING IN A HOSPITAL PATIENTS WEAR HOSPITAL GOWNS OR THEIR NIGHTCLOTHES IN A NURSING HOME RESIDENTS ARE REQUIRED BY THE STATE TO BE DRESSED IN STREET CLOTHES DURING THE DAY IF THE RESIDENT CAN NOT ASSIST, IT IS EASIER AND SAFER TO DRESS THE RESIDENT WHILE SHE IS STILL IN BED.

GUIDELINES FOR DRESSING AND UNDRESSING PROVIDE FOR PRIVACY. DO NOT EXPOSE THE PERSON. ENCOURAGE THE PERSON TO DO AS MUCH AS POSSIBLE. ALLOW THE PERSON TO CHOOSE WHAT TO WEAR. REMOVE CLOTHING FROM THE STRONG OR GOOD SIDE FIRST. PUT CLOTHING ON THE WEAK SIDE FIRST. TOS – TAKE OFF STRONG POW – PUT ON WEAK

A PERSON MAY HAVE TO BE TURNED FROM SIDE TO SIDE AS YOU PUT ON OR REMOVE THEIR PANTS.

DRESSING THE PATIENT WITH AN IV THE GOWN IS FIRST REMOVED FROM THE GOOD ARM. IT IS THEN SLIPPED OVER THE IV SITE AND TUBING TO THE BAG. THE BAG IS PASSED THROUGH THE SLEEVE. THE CLEAN GOWN IS PASSED OVER THE IV BAG. DRESSING THE PATIENT WITH AN IV DO NOT LOWER THE BAG BELOW THE LEVEL OF THE IV SITE